Hildrun Sundseth President

European Institute of Women’s Health

EUGenMed Roadmap for Including Sex & Gender in

Biomedical & Public Health Research

EUGenMed Partners

• Coordinator: Charité-University Medicine Berlin Institute for Gender in Medicine (GIM) • European Institute of Women‘s Health • Maastricht University

• 2 year project, starting Oct 2013

www.eugenmed.eu

EUGenMed Project

• The project will develop a Roadmap for implementing sex and gender aspects into biomedical and health research

• It will build on existing activities to develop an interdisciplinary, inclusive European Gender Health Network.

• Major activities: • Kick-off conference; workshops; roadmap conference • Generating material for different target audiences • Identification of future priorities and recommendations

EUGenMed Roadmap Workshops

• WS 1: Sex and Gender in clinical research and clinical pharmacology (Charité)

• WS 2: Sex and Gender in public health and prevention, focus on risk factors for non-communicable diseases (Maastricht University)

• WS 3: Sex differences in basic biomedical research (Charité)

• WS 4: Sex and Gender in medicines regulation Sex and Gender in medical education (EIWH)

Sex & Gender: IoM Definition

• Sex: Used as a classification, generally as male or female, according to the reproductive organs and functions that derive from chromosomal complement XY vs. XX

• Gender: Used to refer to a person’s self-representation as male or female, or how that person is responded to by social institutions on the basis of the individual’s gender presentation Masculine vs. feminine

The Interaction Between Sex and Gender

Biological Dimension • The biological/ sex

differences between females and males are relevant for the diagnosis, treatment and progression of various diseases and medical conditions.

Social Dimension • Important social

consequences which affect health include education, employment and family life.

• Socio-economic, educational cultural, ethnicity differences can impact on patterns of behaviour and access to resources.

Often Sex and Gender interact - epigenetics

Facts • Women live longer than men • The incidence and prevalence of diseases differ between men and women

• Women have higher rates of osteoporosis, auto-immune diseases, eating disorder, Alzheimers, etc

• Men have higher rates of Parkinsons, chronic liver disease, violence-related injuries, lung cancer, etc

• Some diseases affect men and women differently: CVD, lung cancer, diabetes, depression, etc

Autoimmune Disease: Women and Men

• Higher prevalence in women • Research frequently neglects sex & gender differences

RA Sjögren SLE SSc MS AS0.0

2.5

5.0

7.5

10.0 FrauenMänner

Ratio

F/M

Women Men

RA: rheumatoid arthritis, SLE: lupus erythematodes, SSc: Scleroderma; MS: multple sclerosis, AS: spondylitis ankylosans

Mental Illness: Men & Women

• Men: • Antisocial personality • Substance abuse • Completed suicide

• Women:

• Anxiety, depression • Eating disorders

• Attempted suicide

Prevalence of CVD by Gender and Age

CDC/NCHS and NHLBI 2008

11.2

22.9

86.4

36.2

52.9

68.577.8

6.2

17.6

36.6

56.5

75.0

0102030405060708090

100

20-34 35-44 45-54 55-64 65-74 75+

Ages

Per

cen

t o

f P

op

ula

tio

n

MalesFemales

Medicines Regulation Why consider S&G

• Both Sex and Gender matter in health

• Including Sex and Gender in biomedical research is good science and an important quality and safety issue

• In a just society, biomedical research must provide optimal treatment for both men and women

Medicines Regulation Why consider S&G

• Medicines are safer and more effective for all when clinical research includes diverse population groups of all ages

• Women are under-represented in many clinical trials and if included, robust analysis is often lacking

• Sex differences of tissues and cells, every cell has a sex

• Women metabilise medicines differently example: Ambien - FDA halved dose for women

Health Canada

“The general assumption prevailed that women did not differ from men except where their

reproductive organs were concerned and data obtained from clinical research involving men

could simply be extrapolated to women.”

Considerations for Inclusion of Women in Clinical Trials and Analysis of Data by Sex – 2013 Guidance Document

Sex and Gender in Medicines Regulation

• 62 randomised clinical trials • 380 891 participants • 127 716 women

Percentage (%) of Women in CVD Clinical Trials

Eur Heart J 2010; 31:1677-1685

CVD – Clinical Trials with Analysis by Gender %

Sex and Gender in Medicines Regulation

• Translating the evidence from S&G research into regulatory practice will lead to more targeted, effective opportunities for prevention, diagnosis, treatment and care.

WS Medicines Regulation Recommendations

• Ethics Committees to develop guidelines that address inclusion of women in CTs, following good practice example from Medical University of Vienna

• Stakeholders to propose IMI project to develop robust methodology for subgroup analysis, address existing barriers for the recruitment and retention of women and older people in CTs

WS Medicines Regulation Recommendations

• In preparation of implementing new Clinical Trials Regulation, EMA together with key stakeholders draft Guidelines on S&G analysis in CTs (example: Health Canada)

• Improve rigorous sex and age-specific pharmacovigilance reporting for existing products

• Address knowledge gap: develop regulatory framework for safe use of medicines during pregnancy: post-marketing data collection, common rules for pregnancy exposure registries, etc.

WS Medicines Regulation Recommendations

• EMA to make sex- and age-specific data more readily available and transparent

Example: FDA Snapshot on heart failure drug: Corlanor

Source: FDA, 2015

Example: FDA Snapshot Heart Failure drug: Corlanor

Source: FDA, 2015

Thank you. Any questions?

European Institute of Women’s Health 33 Pearse Street, Dublin 2, Ireland

http://eurohealth.ie +353-1-671-5691 (phone)

This project the European Gender Medicine Network (EUGenMed) has received funding from the European Union’s Seventh Framework Programme for research, technological development and demonstration under

grant agreement No. 602050